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The effect of distance on short-term outcomes in a regionalized, publicly funded bariatric surgery model

机译：距离对区域化，公共资助的畜牧手术模型中短期结果的影响

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BackgroundWhile high-volume Centers of Excellence (COE) for bariatric surgery may have improved clinical outcomes, their disparate distribution results in longer travel distances for patients. The purpose of this study was to investigate effect of distance from COE on outcomes and readmission.MethodsThis was a retrospective study of alladults,aged 18 years or older, receiving bariatric surgery from April 2009 to March 2012 in the province of Ontario. Main outcomes included 30-day complication rates and readmission. Multivariable logistic regression was used to examine the impact of distance from patients' primary residence to their bariatric COE on patient outcomes and readmissions.ResultsFive thousand and seven patients were identified, two-thirds residing within 100km of a COE with a mean distance of 117.2km. The majority of patients did not reside within a Local Integrated Health Network (LHIN) that contained a COE, while 18.3% of patients lived in rural areas. Using multivariable adjustment, for every 10km increase from the COE where surgery was performed, the Odds Ratio (OR) for complications was 1.00 [95% Confidence Interval (CI) 0.99-1.01; P=0.747]. Additionally, both residing in a LHIN without a COE, OR 1.10 (95% CI 0.87-1.40; P=0.434), and rural status, OR 0.97 (95% CI 0.77-1.23; P=0.821) showed no increase in risk of complication. Similarly, further distances did not influence rate of readmission, OR 0.99 (95% CI 0.98-1.00; P=0.077) nor did rural status OR 1.31 (95% CI 0.97-1.76; P=0.076).ConclusionThe COE model, where a few centers in high population areas service a large geographic region, is adequate in ensuring patients that livefurther away receive appropriate short-term care.
机译：卓越（COE）减肥手术的BackgroundWhile大批量中心可以为患者更长的行程距离，提高了临床疗效，其不同的分布结果。这项研究的目的是调查从COE对结果距离的效果，readmission.MethodsThis是alladults的回顾性研究中，年龄在18岁以上，在安大略省接受减肥手术，从2009年4月至2012年3月。主要成果包括30天的并发症发生率和再住院。多因素Logistic回归被用来研究距离的患者主要住宅到他们的肥胖COE对患者的治疗效果和readmissions.ResultsFive二千七百患者的影响被确定驻留在COE 100公里内的117.2公里的平均距离，三分之二。多数患者没有驻留在含有COE本地综合健康网（LHIN）内，而患者的18.3％居住在农村地区。使用多变量调整，用于从在其中执行手术COE每10公里增加出现并发症的比值比（OR）为1.00 [95％置信区间（CI）0.99-1.01; P = 0.747]。此外，无论是居住在LHIN没有COE，或1.10（95％CI 0.87-1.40; P = 0.434），和农村现状，或0.97（95％CI 0.77-1.23; P = 0.821），表明在风险没有增加并发症。类似地，进一步的距离不影响再入院率，OR 0.99（95％CI 0.98-1.00; P = 0.077）也没有农村状态OR 1.31（95％CI 0.97-1.76; P = 0.076）。结论COE模型，其中一个在高人口的地区服务中心几大地理区域，是在确保livefurther远接受适当的短期护理病人足够。

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